APPLICATION FOR 200 HOUR YOGA TEACHER TRAINING, DUBBO 2019
PLEASE PRINT CLEARLY. Today’s Date _________________ 1. PERSONAL INFORMATION: Name ____________________________________________________________________________ Preferred name (if different) ____________________________ Occupation ______________________________ Birth date _____________________________ Age ____ Address _______________________________________________________________________________ _________________________________________________________________________________ Tel (Home) ___________Tel (Bus) _______________________ Tel (Mob) __________________________ E-mail _____________________________________________
Application is for (please tick or circle one option only!) Yoga Teacher Training, 200 Hours, Dubbo (and Coonabarabran) = $3 600 Yoga Teacher Training, 200 Hours, Dubbo (and Coonabarabran) and Siem Reap = $3 600 Yoga Retreat, Siem Reap (100 hours, Foundations of Yoga) = $1 800
2. Why do you want to take this yoga teacher training, and what do you hope to gain? ________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 3. What particular skills and qualities do you bring to this program? __________________________________________________________________________________ __________________________________________________________________________________ ________________________________________________________________________________ 4. YOGA EXPERIENCE:
How long have you practiced yoga? _______________________________________________________________________ Describe your personal practice, what style of yoga and how regularly you practice? _________________________________________________________________________________ ________________________________________________________________________________
5. MEDITATION EXPERIENCE: Do you already practice meditation? If yes, how long have you practiced? ___ ____________________________________________________________________ Describe your personal practice of meditation and how regularly you practice:_________________________________________________________________________________________________________________________________________________________________________________________________________________________
6. Please list ANY OTHER TRAINING you’ve taken in yoga, meditation and/or healing modalities: _________________________________________________________________________________ _________________________________________________________________________________ __________________________________________________________________________________ _________________________________________________________________________________ 7. What does yoga mean to you? __________________________________________________________________________________ ________________________________________________________________________________ __________________________________________________________________________________ 9. Provide the name and contact information of your current yoga teacher; and/or a certified yoga teacher who can give their recommendation of your readiness to participate in this training: _____ ________________________________________________________________________________ 11. HEALTH INFORMATION:
Pregnant? ______If yes, how many weeks? ________ Comments: __________________________________________________________________________________ Medical Questions: Check if any of the following conditions apply. Please explain condition in space provided below. Under medical treatment or supervision for any condition. Current psychotherapy, counselling, psychiatric treatment, hospitalization for psychiatric care. Chronic physical limitations/physical handicaps (i.e., vision, hearing, movement, etc.). Serious illness or major surgery within the last 5 years Prescription medications and/or natural remedies Arthritis Osteoporosis, osteopenia Communicable diseases. Drug or alcohol addiction? Eating disorder? Other _______________________________
If you selected any of the medical conditions above, please describe your condition, and/or nature and extent of limitation:
Attach page, if you need more space.
Our Yoga Teacher Training Program is a recreational drug and alcohol free program, and we cannot negotiate on any infringement on this policy.
12. EMERGENCY CONTACTS: In case of emergency, please contact: ____________________________________________-_____ Phone:
I hereby declare that the above information is true to the best of my knowledge. I understand that misrepresentation of this information is unethical and constitutes grounds for revocation of certification.
I understand the obligation to attend fully all ten weekend workshops in Dubbo or other venue. I understand the obligation to attend weekly classes during the Course. I understand in order to qualify for graduation, I am obliged to pass a written examination (open book) and two practical assessments and complete all assignments. I understand a failed examination, or absence from class requires negotiation with YTT Course Manager and incurs re-sit fees. I understand that parts of the course may be filmed/recorded; and I give permission to be included in filming, photography and recording. I understand that all course material is copyright and available only to students of this course. I will not share any written, photographed, filmed, or recorded material with third parties. I understand that upon offer of place: * an enrolment fee of $600 is due within seven days – this is non refundable unless in the event of insufficient number of enrolments to run the course. * Outstanding Course fees are due in full by 07 January if attending 14 Day Intensive in Siem Reap ($3 000) * Outstanding Course fees are due in full by 28 February if attending cull course in Dubbo (and Coonabarabran) Should there be insufficient number of enrolments to run this course, your fees will be refunded in full.
Signed Date
APPLICATION FOR 200 HOUR YOGA TEACHER TRAINING, DUBBO 2019
PLEASE PRINT CLEARLY. Today’s Date _________________ 1. PERSONAL INFORMATION: Name ____________________________________________________________________________ Preferred name (if different) ____________________________ Occupation ______________________________ Birth date _____________________________ Age ____ Address _______________________________________________________________________________ _________________________________________________________________________________ Tel (Home) ___________Tel (Bus) _______________________ Tel (Mob) __________________________ E-mail _____________________________________________
Application is for (please tick or circle one option only!) Yoga Teacher Training, 200 Hours, Dubbo (and Coonabarabran) = $3 600 Yoga Teacher Training, 200 Hours, Dubbo (and Coonabarabran) and Siem Reap = $3 600 Yoga Retreat, Siem Reap (100 hours, Foundations of Yoga) = $1 800
2. Why do you want to take this yoga teacher training, and what do you hope to gain? ________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 3. What particular skills and qualities do you bring to this program? __________________________________________________________________________________ __________________________________________________________________________________ ________________________________________________________________________________ 4. YOGA EXPERIENCE:
How long have you practiced yoga? _______________________________________________________________________ Describe your personal practice, what style of yoga and how regularly you practice? _________________________________________________________________________________ ________________________________________________________________________________
5. MEDITATION EXPERIENCE: Do you already practice meditation? If yes, how long have you practiced? ___ ____________________________________________________________________ Describe your personal practice of meditation and how regularly you practice:_________________________________________________________________________________________________________________________________________________________________________________________________________________________
6. Please list ANY OTHER TRAINING you’ve taken in yoga, meditation and/or healing modalities: _________________________________________________________________________________ _________________________________________________________________________________ __________________________________________________________________________________ _________________________________________________________________________________ 7. What does yoga mean to you? __________________________________________________________________________________ ________________________________________________________________________________ __________________________________________________________________________________ 9. Provide the name and contact information of your current yoga teacher; and/or a certified yoga teacher who can give their recommendation of your readiness to participate in this training: _____ ________________________________________________________________________________ 11. HEALTH INFORMATION:
Pregnant? ______If yes, how many weeks? ________ Comments: __________________________________________________________________________________ Medical Questions: Check if any of the following conditions apply. Please explain condition in space provided below. Under medical treatment or supervision for any condition. Current psychotherapy, counselling, psychiatric treatment, hospitalization for psychiatric care. Chronic physical limitations/physical handicaps (i.e., vision, hearing, movement, etc.). Serious illness or major surgery within the last 5 years Prescription medications and/or natural remedies Arthritis Osteoporosis, osteopenia Communicable diseases. Drug or alcohol addiction? Eating disorder? Other _______________________________
If you selected any of the medical conditions above, please describe your condition, and/or nature and extent of limitation:
Attach page, if you need more space.
Our Yoga Teacher Training Program is a recreational drug and alcohol free program, and we cannot negotiate on any infringement on this policy.
12. EMERGENCY CONTACTS: In case of emergency, please contact: ____________________________________________-_____ Phone:
I hereby declare that the above information is true to the best of my knowledge. I understand that misrepresentation of this information is unethical and constitutes grounds for revocation of certification.
I understand the obligation to attend fully all ten weekend workshops in Dubbo or other venue. I understand the obligation to attend weekly classes during the Course. I understand in order to qualify for graduation, I am obliged to pass a written examination (open book) and two practical assessments and complete all assignments. I understand a failed examination, or absence from class requires negotiation with YTT Course Manager and incurs re-sit fees. I understand that parts of the course may be filmed/recorded; and I give permission to be included in filming, photography and recording. I understand that all course material is copyright and available only to students of this course. I will not share any written, photographed, filmed, or recorded material with third parties. I understand that upon offer of place: * an enrolment fee of $600 is due within seven days – this is non refundable unless in the event of insufficient number of enrolments to run the course. * Outstanding Course fees are due in full by 07 January if attending 14 Day Intensive in Siem Reap ($3 000) * Outstanding Course fees are due in full by 28 February if attending cull course in Dubbo (and Coonabarabran) Should there be insufficient number of enrolments to run this course, your fees will be refunded in full.